Background: The mis- and overuse of antibiotics continues to be a growing problem in medicine; the results of which are increased health-care costs, increased antibiotic resistance and, ultimately, patient harm. Unnecessary antibiotics are particularly prevalent in the treatment of lower respiratory tract infections (LRTIs) including asthma exacerbations and bronchitis. While it would be nice to simply stop using antibiotics when they’re not indicated, issues in stewardship abound. Amongst these are legitimate concerns by providers that the patient may have a bacterial infection causing their symptoms and, thus, benefit from a course of antibiotics.
Procalcitonin has been touted in recent years as a lab test that can help with this conundrum. Ideally, an elevated procalcitonin level would indicate the presence of a bacterial infection and, thus, suggest benefit from use of antibiotics while a low procalcitonin level would suggest a viral or non-bacterial etiology and suggest an absence of benefit from antibiotics. A recent Cochrane review showed potential for a procalcitonin approach but, there was minimal Emergency Department based evidence. Read more →